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Cicero Chiropractor Settles Civil Health Care Fraud Claims

Joseph Borio Admits that he Caused the Submission of Unsubstantiated Claims for Payment to Medicare and Agrees to Pay Nearly $400,000 to the United States

ALBANY, NEW YORK: Joseph Borio – the owner of Borio Chiropractic Health Center (BCHC), in Cicero, New York – has agreed to pay the United States $376,436.76 to resolve allegations that he violated the False Claims Act by submitting claims to Medicare using higher billing codes than appropriate and falsely certifying that the services billed were medically necessary, announced United States Attorney Richard S. Hartunian. As part of the settlement, Borio admitted that he and others submitted claims to Medicare that are unsupported by his records. He also agreed to implement additional compliance measures as a condition of his continued participation in Medicare and other federal health care programs.

In 2009, federal authorities received information suggesting that Borio had engaged in questionable billing practices. A subsequent investigation revealed that, from May 4, 2006 through April 9, 2008, Borio submitted 10,534 claims for payment to Medicare, which is far more than any other chiropractor in 45 upstate and central New York counties. He also billed for treating as many as 69 Medicare beneficiaries in a given day. Taking into account both Medicare and non-Medicare patients, Borio sometimes billed for personally treating hundreds of individuals in a single day. Of the claims Borio submitted to Medicare during this period, more than 99.9% were billed using the highest-reimbursing billing code (other chiropractors in the region billed that code, on average, just over 13% of the time). During this period, Borio billed that code nearly three times more than the region’s next highest biller. He also treated his Medicare beneficiaries, on average, almost three times more frequently than his peers.

United States Attorney Hartunian said: “The provision of Medicare benefits must be dictated by patient need, not provider greed. Pursuant to federal guidelines, chiropractors are required to submit bills based on the level of treatment required, not the highest rate of payment possible. Today’s settlement demonstrates our commitment to safeguarding the Medicare Trust Fund by holding accountable those providers who inflate their bills to maximize profits.”

“Individuals who defraud health care programs place additional burdens and costs on the health care system, which affects every American citizen. The FBI will continue to work closely with our law enforcement partners to identify individuals who defraud the system for personal gain,” said Special Agent in Charge Andrew W. Vale of the Federal Bureau of Investigation (FBI), Albany Division.

As part of today’s settlement, Borio entered into an integrity agreement with the United States Department of Health and Human Services – Office of Inspector General (HHS-OIG) requiring him and BCHC to engage in strict compliance efforts over the next three years. Under the agreement, Borio is required to retain an independent review organization to review the accuracy of his claims for services furnished to federal health care program beneficiaries.

“When chiropractors try to enrich themselves by misrepresenting the services they bill to taxpayer-funded health care programs, we will work hard to make sure they are held accountable for their deceptive schemes,” said Special Agent in Charge Thomas O’Donnell of HHS-OIG’s New York region.

This investigation and settlement were the result of a coordinated effort between the United States Attorney’s Office for the Northern District of New York, the FBI, HHS-OIG, and SafeGuard Services LLC (a Program Safeguard Contractor responsible for investigating fraud, waste, and abuse to the Medicare Program). The United States was represented by Assistant United States Attorney Adam J. Katz.